EFFICACY OF HEMOSTATIC POWDERS IN THE TREATMENT OF GASTROINTESTINAL BLEEDING RELATED TO NEOPLASTIC OR NON-NEOPLASTIC LESIONS

Aims EndoClot System and Hemospray are two hemostatic powders (HPs) recently introduced in the treatment of gastrointestinal bleeding (GIB). Aim of the study was to evaluate the efficacy and safety of HPs in the management of GIB.

Methods From September 2017 to September 2019, all patients with lesions actively bleeding not responding or not amenable to be managed with standard procedures of hemostasis (local adrenaline infiltration, argon plasma coagulation or electrohemostasis, mechanical with clips) were treated with HP. Hemostasis achieved with HP was defined as immediate (no bleeding up to end of the procedure), stable (no rebleeding within the 72 hours after the procedure), or definitive (no more episodes of bleeding till the discharge).

Results HPs were used in 37 patients (25 males; median age: 69.5 years, range: 32-89) with GIB due to chemotherapy-related mucosal damage or graft versus host disease (2 patients, both with extensive mucosal denudation in the esophagus); ulcer in the stomach (3 patients), in the duodenum (6 patients), and in the gastric anastomosis (5 patients); inoperable malignancy infiltrating the wall of the stomach (11 patients), duodenum (4 patients), or colon/rectum (2 patients); post-endoscopy procedures (sphincterotomy in 2 patients and endoscopic submucosal dissection in the rectum in 1 patient), colonic vascular malformation (1 patient). 27/37 (73%) were at first episode of GIB while 10 had already been submitted to an endoscopic hemostatic procedure for GIB. HPs achieved immediate hemostasis in 35/37 patients (95%), stable hemostasis in 26 patients (70%) and definitive hemostasis in 22 patients (59%). No adverse events occurred.

Conclusions The HPs are effective for stopping GIB related to different kinds of neoplastic and not neoplastic lesions, not responding or not amenable to be treated with standard hemostatic techniques.